Provider Demographics
NPI:1639971856
Name:JOHNS, KELLY (MS RD CDCES)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:JOHNS
Suffix:
Gender:
Credentials:MS RD CDCES
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 521156
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84152-1156
Mailing Address - Country:US
Mailing Address - Phone:801-215-9650
Mailing Address - Fax:
Practice Address - Street 1:650 S 1000 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3908
Practice Address - Country:US
Practice Address - Phone:801-215-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10547276-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered